Texas Gulf Coast (TGC) Graduate Nurse Education (GNE) Demonstration

1. Texas Gulf Coast (TGC)Graduate Nurse Education (GNE) Demonstration Lori Hull-Grommesh, DNP ACNP-BC CCRN NEA-BC Director, Texas Gulf Coast Graduate Nurse Education Demonstration

2. Shortages of APRNs/MDs • Texas, as well as, the country face a shortage of physicians and other health care providers and it is expected to grow worse as more people gain health insurance and with the aging and growing population • The total number of people expected to gain health insurance is expected to increase to 30 million by year 2016 • By 2019, the demand for primary care in the US will increase between 15 million and 25 million visit per year • Texas has a critical shortage of APRNs – national ratio is 27.7 per 100,000 – Texas ratio is 17.7 per 100,000 • CRNAs are in short supply – national average of 8.1 per 100,000 – Texas average is 6.3 per 100,000 • Requiring between 4,000-7,000 more physician to meet this new demand

3. Purpose of Demonstration • Memorial Hermann - one in five nationwide hospitals selected to receive federal funding from the Centers for Medicare and Medicaid Services (CMS) for participation in the GNE Demonstration (July 2013) • Funding- $200M over 4 years to the five selected sites: CMS authority for up to $50M/year (2012-2016) • GNE Demonstration payment for reasonable costs for qualified clinical training for Advance Practice Registered Nurses (APRNs) • Purpose: • Provide Texas Medicare beneficiaries with improved access to health care provider services by significantly increasing the number of APRNs educated in the Texas Gulf Coast Region • Create an efficient partnership collaborative, replicatable, networking model between hospitals, regional nursing schools and clinical partners • Allows monitoring, collection and information exchange (‘best practices,” etc.) through coordinated communication between regional health care systems, nursing programs, and clinical partners

4. Partnerships • Schools of Nursing • Prairie View A&M University • Texas Woman’s University • University of Texas Health Science Center at Houston • University of Texas Medical Branch at Galveston • Gateway to Care • Community Healthcare Partnerships • Fourteen (14) hospitals – 11 - Memorial Hermann • Four (4) hospital-based physician partners • Approximately 50 community-based partners with a number of clinical preceptor sites

5. Demonstration Footprint Community Healthcare Partnerships across eight counties with over fifty partners consisting of over 300 clinical preceptors. Partnership includes: GNE partners: • Hospital based physician partners • University physician practices • Community Clinics • Federally Qualified Health Clinics • Physician Practice Clinics • Advance Practice Provider Clinics

6. Preceptor Placement Sites

7. Placement Outreach Strategy

8. Advance Practice Registered Nurses --Vital to Our Community • Will be utilized to the full extent of their education and training. • Provide independent assessment, diagnosis and management of acute and chronic health care problems. • Increase the quality of outcome for patients • Enhance patient satisfaction • Reduce patient readmissions and reduce healthcare cost • Increase healthcare services to underserved areas • Provide education that promotes healthcare wellness and maintenance • Advance health care • Drive, assist and create new healthcare models • Provide transitional care for patients from hospital to the home setting

9. APRN Requirements • Current State of Texas license to practice professional nursing and a BSN • Graduate of a Nurse Practitioner Program approved by the State of Texas • Certification by the American Nurse Credentialing Center or National Certification Center in area of specialty • Collaborative practice agreement

10. Demonstration Year 1 Highlights

11. Going Forward – Year 2

12. Feedback from APRN Students and Preceptor • “I’m confident that when I graduate as an APRN, I will be ready to fill in the gaps in our health care system that are currently underserved.” • “It was a fantastic experience and I didn't realize how much I learned until this current semester. Your knowledge has “stuck” with me greatly.” • “My preceptors, Mark, Kristie and Beth helped me tremendously.  They never tired of my many questions and always found material or ways to explain issues that helped me gain a better understanding of the overall clinical picture.” • “I wanted to let you know that overall I have had a positive experience as a first-time physician preceptor this summer in my pediatric office.”

13. http://www.memorialhermann.org/careers/graduate-nursing-education-demonstration/http://www.memorialhermann.org/careers/graduate-nursing-education-demonstration/

14. Senate Bill 406 • Eliminates the current site-based requirements • Standardized prescriptive authority agreement • Non-hospital physicians can delegate prescriptive authority to seven APRNs as opposed to four previously • Physicians can delegate prescriptive authority for Schedule IIs Controlled Substances to APRNs and PAs in hospitals and hospice • Ensures that APRNs and PAs are recognized the same as physicians in Medicaid and CHIP for reimbursement Recognized as Primary Care Provider • Effective November 1, 2013

15. Questions